From the Guidelines
To check for radial pulse delay, simultaneously palpate the radial and femoral pulses is not the correct approach, instead, simultaneously palpate the radial pulse in one arm and either the carotid, or opposite radial pulse with your other hand, as there is no direct evidence to support checking radial pulse delay by comparing it to the femoral pulse in the context of radial pulse delay assessment. When checking for radial pulse delay, it is essential to consider the potential causes of such a delay, including vascular obstruction or aortic disease, as suggested by the guidelines for the management of adults with congenital heart disease 1. To perform the assessment:
- Place your index and middle fingers over the pulse points and feel for any difference in timing between the two pulses.
- For the radial pulse, press gently against the radius bone on the thumb side of the inner wrist.
- For the carotid, place your fingers in the groove between the trachea and sternocleidomastoid muscle in the neck.
- For the opposite radial pulse, use the same technique as for the initial radial pulse. A significant delay may suggest conditions like aortic coarctation, aortic dissection, or subclavian steal syndrome, and this assessment is valuable because pulse delays reflect blood flow obstructions that may require further investigation with imaging studies, such as those recommended for suspected aortic coarctation, including initial imaging and hemodynamic evaluation by TTE, and cardiovascular MRI or CT scan 1. The technique requires minimal pressure to avoid occluding the vessels, especially when checking the carotid pulse to prevent carotid sinus stimulation. In clinical practice, simultaneously palpating the radial and carotid or opposite radial pulses is a practical approach to assess for radial pulse delay, given the lack of direct evidence supporting the use of femoral pulse comparison in this specific context.
From the Research
Checking for Radial Pulse Delay
To check for radial pulse delay, the following steps can be considered:
- Assessing the radial pulse wave using non-invasive methods such as applanation tonometry 2
- Evaluating the maximal first derivative of the radial pulse (Rad dP/dt) as a peripheral criterion of ventricular contractility in patients with heart failure 2
- Using differential latency testing, a modified electrodiagnostic test, to evaluate radial tunnel syndrome 3
- Considering radial access for neurovascular procedures, which has been proven to be safer and the preferred access route by most patients 4
Key Factors to Consider
Some key factors to consider when checking for radial pulse delay include:
- The feasibility and reproducibility of the assessment method 2
- The correlation between radial pulse wave assessment and classical parameters of left ventricular function 2
- The presence of radial tunnel syndrome, which can be indicated by a differential latency of > or =0.30 ms 3
- The advantages and limitations of radial access for neurovascular procedures, including the lack of dedicated equipment and physician bias toward femoral access 4
Assessment Methods
Different assessment methods can be used to check for radial pulse delay, including: